Medicare Benefits Schedule Review Consultation :President Report Dr Sue Andrews

On 26 October I attended a Consumer Workshop in Sydney, one of several convened by the Consumers’ Health Forum as part of the government’s consultation process for the Review of the Medicare Benefits Schedule (MBS).

The workshop was attended by a diverse range of consumer advocates and organisations including Breast Cancer Network Australia, Pain Australia, and the Australian Patients Association. 

The Minister for Health, Sussan Ley, gave some introductory comments about why the MBS needs to be reviewed and why consumer and carer input is critical to that process.

Professor Bruce Robinson, Chair of the Review Taskforce, then gave an overview of the Review, key issues in the Consultation Paper which is providing the basis for their call for public submissions.

Professor Robinson also provided an update on progress with the Review. Its first report to Government is due in December 2015.

MBS review activities have been distributed among several groups including Clinical Committees, a Principles and Rules committee and Item-specific working groups.

Of the 30 Clinical Committees, 6 priority areas were launched in October – Obstetrics, ENT, Gastroenterology, Thoracic Surgery, Pathology and Diagnostic Imaging.

The input received so far draws on a wide variety of experiences with the MBS:

•  250 people have submitted feedback online, representing all states and territories.

•  126 clinicians or health professional organisations, 96 consumers or carers, 20 others.

•  Carried out a triage of items,

• Created a preliminary list of obsolete items is being examined further,

• Targeted areas are being moved into evaluation (eg sleep studies, pre-natal testing) and,

•  Several new items have been proposed.

• Referral regulation: Consumers and clinicians have asked to re-evaluate the three month limit on specialist to specialist referrals. This limit can force clinically unnecessary ‘renewal’ consultations.

• Rural Delivery: As rural delivery models and workforce levels evolve, stakeholders have asked for updates to geographic adjustments such as exemptions and cost adjustments.

• Ongoing item reviews: Stakeholders suggest that more frequent ongoing reviews could make the MBS a ‘living document’ improving the quality and relevance of procedures for patients.

The Review has already;

The Rules Committee is considering cross-cutting issues whose implications extend across the Clinical Committees including but not limited to;

Finally, there was some focused discussion around the key themes of the inquiry – unnecessary medical consultations, procedures or tests; application of Medicare rules; information requirements to make decisions about services; and how consumers could be engaged in the review process. 

The final discussion explored how consumers and carers could be better engaged in the Review process. The Review Taskforce have suggested consumers be involved as members of Clinical Committees, through public consultation on draft recommendations and through health consumer organisations. However they don’t have a clear consumer engagement strategy at this stage. Participants discussed other options such as social media and pointed out the importance of meaningful engagement with Aboriginal and/or Torres Strait Islander communities, Culturally and Linguistically Diverse communities, and refugee and migrant communities.

The MBS Review website contains all relevant information about the program, including outcomes of the consumer and stakeholder forums:

http://www.health.gov.au/internet/main/publishing.nsf/content/consultation-mbsreviewtaskforce

Dr Sue Andrews

President, HCCA

Health in Difference Conference Report By Elizabeth Proctor Health Care Consumers’ Consumer Representative & Eleanor Kerdo Policy Officer HCCA

Elizabeth Proctor:

In mid August I was lucky enough to attend the first day of the 9^th National LGBTI Health Conference Health in Difference (and I apologise for the delay in reporting back!). The most striking thing about the conference was how thoughtfully the program and speakers engaged with the overlaps and interactions between healthcare provision and marginalisation of groups. A special focus was placed on how Aboriginal and Torres Strait Islander and culturally and linguistically diverse LGBTI peoples face multiple disadvantages, both when seeking healthcare and more broadly.

The conference speakers shared stories that showed how far we’ve come in LGBTI communities, but also how much work remains – a lesbian mother who in the 1990s snuck into hospital to care for her baby (it took the hospital a week to notice there were two mums taking turns), Bob Brown’s memories of shock therapy and seeking out so many psychiatrists before finding one who gave him the best advice (‘Bob, sounds like you’re gay. Why don’t you try accepting it?’), Muslim-Australian siblings challenging the western notion of ‘coming out’ (instead, invite your loved ones into your life), and lawyers advocating for sex-positive aged care facilities (why aren’t there any double beds?). In a bright spot for aged care, Human Rights Commissioner Gillian Triggs pointed out that the recent change of law for inclusive facilities was almost surprisingly uncontroversial; updating the Sex Discrimination Act so religious aged care facilities were not exempt from LGBTI non-discrimination was met with general acceptance across the community.

Eleanor Kerdo:

On day 2 Eleanor swapped in and attended the ageing and aged care stream. There are lots of organisations working on making aged care facilities (ACF)  and services more LGBTI inclusive, both at a policy and personal level. Silver Rainbow is offering training on inclusive practice to ACF staff, while the Department of Social Services is developing formal standards for LGBTI inclusive aged care. Palliative Care Australia is similarly working on LGBTI specific policy frameworks. On a frontline service level, Switchboard Victoria provides community connections to isolated LGBTI elders through the good old cup of tea, connecting them to new friends who can build their confidence and support them settling into aged care.

Philomena Horsley of Gay and Lesbian Health Victoria (LaTrobe University) presented on LGBTI people’s experiences in end of life care and reflected on the history of end of life care in the LGBTI community. At the height of the 1980s HIV-AIDS epidemic, the LGBTI community was at the centre of an underground end of life care and euthanasia movement to support terminally ill patients with AIDS. At that time a large number of nurses and doctors could see a clear need for those services and took big personal risks to provide care. As conversations about dying with dignity become prevalent again it is timely to reflect on those moments in history that were so compelling to past generations.

Several community groups expressed an interest in HCCA’s Advance Care Planning Project, and Christine is looking forward to working with LGBTI communities in Canberra to help people develop aged care plans that work for them.

Thanks for sending us to this conference we thought it was excellent!